CREA Agreement 2011-13 - Caesar Rodney School District

Schedule D -- Group Dental Insurance
Caesar Rodney School District
EMPLOYEE PROGRAM
Dental Treatment Costs
Dental Services Proposed Paid by Delta Paid by Patient
DIAGNOSTIC 100% 0%
PREVENTIVE 100% 0%
BASIC RESTORATIVE 100% 0%
ORAL SURGERY 100% 0%
ENDODONTIC 100% 0%
PERIODONTIC 100% 0%
MAJOR RESTORATIVE 80% 20%
PROSTHODONTICS 80% 20%
ADULT ORTHODONTICS 60% 40%
SEALANTS 50% 50%
Maximum -- $1,250 per person per calendar year. Orthodontics has a separate maximum of $1,000 lifetime per
patient.
DEPENDENT PROGRAM
Dental Treatment Costs
Dental Services Proposed Paid by Delta Paid by Patient
DIAGNOSTIC 90% 10%
PREVENTIVE 90% 10%
BASIC RESTORATIVE 90% 10%
ORAL SURGERY 90% 10%
ENDODONTIC 90% 10%
PERIODONTIC 90% 10%
DEPENDENT ORTHODONTICS 50% 50%
SEALANTS 50% 50%
Maximum -- $1,000 per person per calendar year. Orthodontics has a separate maximum of $1,000 lifetime per
patient.
Eligible dependent children are covered to age 19, unless they are students in a bona fide institution of higher
education, in which case, eligibility is extended to age 23. Mentally retarded dependent children are eligible for dental
care under the program regardless of age, as are physically incapacitated children who are incapable of self-support.
Orthodontics is a benefit for dependent children to age 19.
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